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Abstract Introduction The biggest barrier to adequate treatment for obstructive sleep apnea (OSA) is the underdiagnosis of the condition. It is important to understand the diversity of clinical characteristics of people with OSA, so that clinicians can better screen for OSA and improve the rate of diagnosis. Using real-world data of people diagnosed with OSA who go on to receive positive airway pressure (PAP) treatment, we sought to describe the presentation of OSA at the time of diagnosis. Methods This was a retrospective cohort study conducted among people who had a OSA confirmed by a sleep test (index date) between January 2019 and February 2023 and later started on PAP therapy. De-identified insurance claims data were linked with PAP data and electronic medical records. Characteristics from the year prior to index included demographics, body mass index (BMI), presence of comorbid conditions, and laboratory results. BMI and laboratory results were averaged only amongst those who had a measurement. Results The final sample included 211,089 people with newly diagnosed OSA. Of these, 47% were female, 61% were between the ages of 45 and 64, with an average age of 51.5 years. On average, patients had 3.3 other conditions at the time they were diagnosed with OSA and 90% were managing at least one other chronic condition (60% hypertension, 54% hyperlipidemia, 31% anxiety, 31% gastroesophageal reflux disease, 29% depression, and 26% type 2 diabetes). Average blood pressure readings were 131/80 indicative of stage 1 hypertension. Average total cholesterol was in normal range at 184mg/dL, and average A1C was 6.4 indicative of prediabetes. 59% had at least class 1 obesity, and the average BMI was 35.0 kg/m2. Compared to men, women were older, had more conditions, lower blood pressure, and higher cholesterol. The prevalence of women and mean number of conditions increased by age, while BMI and cholesterol decreased by age. Conclusion These real-world data show that diagnosis of OSA typically occurs during middle-age for women and men, and commonly presents with mild hypertension or prediabetes. These data should be used to raise awareness of the presentation of OSA to improve the rate of diagnosis. Support (if any) ResMed